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General NPI Number Information
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NPI Number | 1851710032
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Entity Type | Organization
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Legal Business Name | WESLEY W.O. KRUEGER M.D. PLLC
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Dates
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Enumeration Date | 04/15/2014
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Last Update Date | 04/15/2014
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Provider Practice Location Address
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Address Line | 2632 BROADWAY ST STE 201
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City | SAN ANTONIO
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State | TX
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Zip | 78215-1137
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Country | US
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Telephone | 210-854-2931
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Fax |
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Provider Business Mailing Address
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Address Line | 103 GATEWOOD CT
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City | SAN ANTONIO
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State | TX
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Zip | 78209-5427
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Country | US
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Telephone | 210-854-2031
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. WESLEY W KRUEGER
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Credential | M.D.
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Telephone | 210-854-2031
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207YX0901X
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Taxonomy Name | Otology & Neurotology Physician
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License Number |
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License Number State | TX
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